Abundant Life Dietetics ServicesAbundant Life Dietetics ServicesPrivate Practice & Consultancy ServicesPrivate Practice & Consultancy Services

Nutrition & DieteticsNutrition & Dietetics

Village Medical CentreVillage Medical CentrePlot 4921 Mosebele Road, Village, GaboronePlot 4921 Mosebele Road, Village, Gaborone

Kgomotso P. Vasco, Dietitian RDKgomotso P. Vasco, Dietitian RDKings College London UniversityKings College London University

NUTRITION AND CANCERNUTRITION AND CANCER

PresentsPresents

NUTRITION AND CANCERNUTRITION AND CANCER

OUTLINEOUTLINE

Evidence for an anti-cancer dietEvidence for an anti-cancer diet Purpose of Nutrition carePurpose of Nutrition care Drug and nutrient interactionDrug and nutrient interaction

EVIDENCE EVIDENCE FOR AN ANTI-CANCER DIETFOR AN ANTI-CANCER DIET

““An estimation of 30-40 percent of cancers An estimation of 30-40 percent of cancers can be prevented by lifestyle and dietary can be prevented by lifestyle and dietary

measures alone.”(Donaldson,2004)measures alone.”(Donaldson,2004)

DIETARY FACTORS THAT PROMOTE DIETARY FACTORS THAT PROMOTE CANCER RISKCANCER RISK

ObesityObesity - - second leading cause of cancer (fat) second leading cause of cancer (fat)

Nutrient sparse foods Nutrient sparse foods - concerntrated sugar- concerntrated sugar - refined flour products- refined flour products

Foods with a high glycaemic load are associated to cancer (Risk with Foods with a high glycaemic load are associated to cancer (Risk with gastric, upper aero digestive tract, endometrial, ovarian and colon or gastric, upper aero digestive tract, endometrial, ovarian and colon or colorectal cancers) colorectal cancers)

Impaired Glucose Metablolism – strong link between diabetes, (High Impaired Glucose Metablolism – strong link between diabetes, (High HbA1C, elevated fasting insulin) and colorectal cancerHbA1C, elevated fasting insulin) and colorectal cancer

Food contributing to hyperinsulinemia should be avoidedFood contributing to hyperinsulinemia should be avoided

DIETARY FACTORS THAT PROMOTE DIETARY FACTORS THAT PROMOTE CANCERCANCER RISK RISK

Low fibre dietsLow fibre diets

Dairy products, eggs, all meats and refined grainsDairy products, eggs, all meats and refined grains

There is an inverse correlation of high fibre foods with rectal There is an inverse correlation of high fibre foods with rectal cancercancer

Fibre is also rich in micro nutrients which have anti cancer Fibre is also rich in micro nutrients which have anti cancer propertiesproperties

Red meatRed meat Meat and meat products and heterocyclic amines formed in Meat and meat products and heterocyclic amines formed in cooking promote colorectal and breast cancers.cooking promote colorectal and breast cancers.

DIETARY FACTORS THAT PROMOTE DIETARY FACTORS THAT PROMOTE CANCERCANCER RISK RISK

Imbalance of omega 3 and omega 6 fatsImbalance of omega 3 and omega 6 fats

Omega 3 fats (alpha-linolenic acid, EPA,DHA) - protective of Omega 3 fats (alpha-linolenic acid, EPA,DHA) - protective of cancercancer

Omega 6 fats (linoleic acid, arachidonic acid) – cancer Omega 6 fats (linoleic acid, arachidonic acid) – cancer promoting fatspromoting fats

Breast tumour suppressor genes BRCA1 and BRCA2Breast tumour suppressor genes BRCA1 and BRCA2

Flax seedFlax seed – lignan fraction – lignan fraction

Good source of dietary fibre and omega 3 fatsGood source of dietary fibre and omega 3 fats

Lignan in flax seed is digested to Lignan in flax seed is digested to enterodiolenterodiol and and enterolactoneenterolactone which have esterogenic activity. which have esterogenic activity.

Lignan fraction Lignan fraction secoisolariciresinol diglycosidesecoisolariciresinol diglycoside (SDG) and the flax seed can reduce metastsis and (SDG) and the flax seed can reduce metastsis and reduce tumor growth.reduce tumor growth.

Fruits and vegetablesFruits and vegetables

Fruits and vegetablesFruits and vegetables (Block et al,1992) found that 128 out of 158 studies found fruits and (Block et al,1992) found that 128 out of 158 studies found fruits and vegetables to be protetive against cancer.vegetables to be protetive against cancer.

They are protective to the stomach, oesophagus, lung, oral cavity and They are protective to the stomach, oesophagus, lung, oral cavity and pharynx, endometrium, pancreas and colon.pharynx, endometrium, pancreas and colon.

Vegetables especially raw are more protective.Vegetables especially raw are more protective.

- Alllium vegetables ( onions, garlic, leeks, and scallions)- Alllium vegetables ( onions, garlic, leeks, and scallions)- Cruciferous vegetables (cabage,cauliflower, brussel sprouts, brocolli) / - Cruciferous vegetables (cabage,cauliflower, brussel sprouts, brocolli) /

sulforophane much richer in brocolli sprouts

- Green vegetables - chlorophyll- Green vegetables - chlorophyll- Carrots - carotenoids- Carrots - carotenoids

There are many nutrients and phytochemicals that are found in fruits and There are many nutrients and phytochemicals that are found in fruits and vegetables such that the protective effect can not be due to one nutrient vegetables such that the protective effect can not be due to one nutrient or phytochemical.or phytochemical.

SeleniumSelenium

A mineral with anti cancer propertiesA mineral with anti cancer properties

Selenium Functions Selenium Functions - Present in active site of many enzymes, including thioredoxin reductase Present in active site of many enzymes, including thioredoxin reductase

which catalysis oxidation-reduction reaction.These reactions may which catalysis oxidation-reduction reaction.These reactions may encouage cancer cells to under apoptosis.encouage cancer cells to under apoptosis.

- Component of anti oxidant enzyme glutathione peroxidaseComponent of anti oxidant enzyme glutathione peroxidase- Causes formation of natural killer cellsCauses formation of natural killer cells- P450 enzymes in the liver may be induced by selenium, leading to P450 enzymes in the liver may be induced by selenium, leading to

detoxification of some carcinogenic molecules.detoxification of some carcinogenic molecules.- Inhibits prostaglandins that cause inflamationInhibits prostaglandins that cause inflamation- Improves the immune systems‘ ability to respond to infectionImproves the immune systems‘ ability to respond to infection- Can decrease rate of tumour growthCan decrease rate of tumour growth

Dietary sourcesDietary sources - whole grains, legumes, brazil nuts, sunflower, yeast - whole grains, legumes, brazil nuts, sunflower, yeast

oo ChloropphyllChloropphyllGreen colour in plants, the light collecting molecule.Green colour in plants, the light collecting molecule.

- Chlorophyl and its derivatives are very effective at binding Chlorophyl and its derivatives are very effective at binding polycyclic aromatic hydrocarcarbonspolycyclic aromatic hydrocarcarbons (carcinogens (carcinogens largely from incomplete combustion of fuels), largely from incomplete combustion of fuels), heterocyclic heterocyclic aminesamines (generated whe grilling food), (generated whe grilling food), aflotaxinsaflotaxins (toxin (toxin from molds in foods which causes liver cancer), and other from molds in foods which causes liver cancer), and other hydrophobic moleculeshydrophobic molecules..

- The chlorophyl-carcinogen complex is difficult for the body The chlorophyl-carcinogen complex is difficult for the body to absorb, therefore most of it is swept out with the stool.to absorb, therefore most of it is swept out with the stool.

Vitamin B-12Vitamin B-12Evidence of anti cancer effect havs been seen in experimental studies. Evidence of anti cancer effect havs been seen in experimental studies. Not yet proven. Cohort studies need to be carried out.Not yet proven. Cohort studies need to be carried out.

Folic AcidFolic Acid- Dark green leafy vegetable vitamin.- Dark green leafy vegetable vitamin.

- Follic acid works with B6 and B12. If Folic acid is insufficient, - Follic acid works with B6 and B12. If Folic acid is insufficient, uraciluracil is is

substituted for substituted for thymidinethymidine in DNA, which leads to strand breakage. in DNA, which leads to strand breakage. This then promotes DNA methylation. This then promotes DNA methylation.

- Folate reverses DNA methylation.- Folate reverses DNA methylation.

- Alcohol is an antagonist to folate- Alcohol is an antagonist to folate

- Folate may be important for the rapidly dividing tissue like the colonic - Folate may be important for the rapidly dividing tissue like the colonic mucosa.mucosa.

Alpha and Beta Carotene and other CarotenoidsAlpha and Beta Carotene and other Carotenoids

Alpha caroteinoids (carrots, pumpkin, winter squash) are more protective Alpha caroteinoids (carrots, pumpkin, winter squash) are more protective from cancer than Beta cartenoids.from cancer than Beta cartenoids.

Lycopene – more abundant in tomato. More bioavailable in cooked tomato Lycopene – more abundant in tomato. More bioavailable in cooked tomato than the raw. Protect against prostrate cancer.than the raw. Protect against prostrate cancer.

Vitamin CVitamin C

More effective given intraveneously. Oral dose of Vit C do not give More effective given intraveneously. Oral dose of Vit C do not give adequate serum concerntration as when injected.adequate serum concerntration as when injected.

1.25g orally 1.25g orally - 135umol- 135umol1.25 intraveneously 1.25 intraveneously - 885umol- 885umol

Other AntioxidantsOther Antioxidants

Grape seed extract – Grape seed extract – proanthocyanidin proanthocyanidin (anti carcinogenic)(anti carcinogenic)Green tea- flavanol, epigallocatechin-3-gallate (EGCG)Green tea- flavanol, epigallocatechin-3-gallate (EGCG)

ProbioticsProbioticsStill being studied. To increase pro biotics you have to eat a lot of prebiotics Still being studied. To increase pro biotics you have to eat a lot of prebiotics (Fibre).(Fibre).

Oral EnzymesOral EnzymesMost cancer patients will have impaired digestion or intestinal tract disoder. Most cancer patients will have impaired digestion or intestinal tract disoder. Therefore lessen the digestive side effectsTherefore lessen the digestive side effects

Proteases - if they reach the circualory system they have anti tumour effect.Proteases - if they reach the circualory system they have anti tumour effect.

Enzyme suplementation reduces side effects of cancer therapyEnzyme suplementation reduces side effects of cancer therapy

Need more evidence – more studies to be carried out to confirm findings.Need more evidence – more studies to be carried out to confirm findings.

ConclusionConclusion The American Institute for Cancer Research have the The American Institute for Cancer Research have the

following cancer prevention guifdelinesfollowing cancer prevention guifdelines

- Eat a plant based diet. Eat atleast 5 servings of fruit and Eat a plant based diet. Eat atleast 5 servings of fruit and vegetables daily. Include beans in the diet and eat grain vegetables daily. Include beans in the diet and eat grain products (such as cereals, breads, and pasta)products (such as cereals, breads, and pasta)

- Choose foods low in fatChoose foods low in fat- Choose foods low in saltChoose foods low in salt- Get to and stay at a healthy weightGet to and stay at a healthy weight- Be at least moderately active for 30 minutes on most days Be at least moderately active for 30 minutes on most days

of the weekof the week- Limit alcohol drinksLimit alcohol drinks- Prepare and store food safelyPrepare and store food safely- Do not use tobacco in any formDo not use tobacco in any form

FOOD PYRAMIDFOOD PYRAMID

Purpose of Nutrition carePurpose of Nutrition care

To restore or conserve nutitional status, To restore or conserve nutitional status, body composition, and functional status body composition, and functional status prior, during and after cancer treatment.prior, during and after cancer treatment.

To minimise food related discomforts To minimise food related discomforts associated with cancer and its treatmentassociated with cancer and its treatment

To improve strength and well being and To improve strength and well being and quality of life.quality of life.

Effects of treatment of Effects of treatment of cancer on nutritional statuscancer on nutritional status

Sugery - Sugery - (dumping syndrome, fat malabsorption, steatorrhea,and (dumping syndrome, fat malabsorption, steatorrhea,and deficiencies in iron, calcium, fat solublevitamins and vitamin B12)deficiencies in iron, calcium, fat solublevitamins and vitamin B12)

Chemotherapy - Chemotherapy - (anorexia, nausea, vomiting, diarrhea, (anorexia, nausea, vomiting, diarrhea, stomatitis, constipation, taste changes)stomatitis, constipation, taste changes)

Radiation therapy - Radiation therapy - (nausea, vomiting, diarrhea, (nausea, vomiting, diarrhea, stomatitis,dry mouth, swallowing problems, oesophageal reflux, fistular, stomatitis,dry mouth, swallowing problems, oesophageal reflux, fistular, oesophageal fibrosis or stricture, dysphagia, tiredness)oesophageal fibrosis or stricture, dysphagia, tiredness)

Nutrition Therapy Nutrition Therapy

Diet modification Diet modification - High Calorie High Protein- High Calorie High Protein

- texture modification- texture modification

- restricted fibre- restricted fibre

- High fibre - High fibre

Nutrition Supplement drinksNutrition Supplement drinks Enteral NutritionEnteral Nutrition Parenteral NutritonParenteral Nutriton

Advaned CancerAdvaned Cancer

Palliative carePalliative care

- LessLess solid food and clear liquids better tolerated.solid food and clear liquids better tolerated.

- Terminally ill will feel less hungry and eat less.- Terminally ill will feel less hungry and eat less.

- View food as a source of enjoymentView food as a source of enjoyment

- Dietary restriction not ussually neccessary unless if the diet may Dietary restriction not ussually neccessary unless if the diet may cause complications such as bowel blockage.cause complications such as bowel blockage.

DRUG NUTRIENT DRUG NUTRIENT INTERACTIONINTERACTION

BexaroteneBexarotene - grapefruit may increase a drug‘s - grapefruit may increase a drug‘s effectseffects

MethotrexateMethotrexate - Alcohol may cause liver damage- Alcohol may cause liver damage PlicamycinPlicamycin - Supplements of calcium and vit D - Supplements of calcium and vit D

may decrease the drug‘s effectmay decrease the drug‘s effect ProcarbazineProcarbazine - Alcohol may cause a reaction - Alcohol may cause a reaction

that that includes flushing of the skin, includes flushing of the skin, breathing difficulty, nausea, breathing difficulty, nausea,

and low and low blood pressure. Caffeine blood pressure. Caffeine may raise may raise blood presure.blood presure.

TemozolomideTemozolomide - Food may slow or decrease the - Food may slow or decrease the drugs effect. drugs effect.

Good nutrition, AdequateGood nutrition, Adequate

Exercise and rest will add Exercise and rest will add

more good years to your more good years to your

life. life.

Try it!Try it!

THANK YOU!THANK YOU!